August 2nd, 2010
Parents across the UK are understandably being made anxious by news reports today suggesting:
Rise in 11 year olds on the pill (Sunday Times)
One thousand girls on Pill at 11: Huge rise in contraceptive prescription for pre-teens without parents knowing (Daily Mail)
Huge rise in 11-year-olds on the pill (Telegraph)
The UK appears afflicted by ‘soaring’ numbers of sexually active girls, who lie to parents, enabled by GPs.
Is it accurate?
Where did the story come from?
These reports are based on figures from the General Practice Research Database (GPRD), indicating 1000 11-12 year olds annually are prescribed hormonal contraceptives (usually the pill or injection).
This was picked up by firstly the Sunday Times then spread to other newspapers, websites and broadcast media. As we’ll see journalists did not show due diligence in investigating the story.
Are 11 year old girls using hormonal contraceptives?
Yes. But despite the media hype there are many medical reasons why young girls might be prescribed hormonal contraceptives including:
- Heavy periods (resulting in excessive bleeding, vomiting, diarrhoea)
- Polycystic Ovary Syndrome (PCOS)
- Irregular periods
- Amenorrhea (no periods due to extreme weight loss, anorexia, or side effects of radiation/chemotherapy)
Taking hormonal contraception is, for many girls, a means of ensuring they don’t miss school. It reduces symptoms that could be painful, distressing and single them out for bullying. When the pill is prescribed for medical reasons usually it is parents, in discussion with their daughters, who initiate contact the GP.
Of course hormonal contraception also prevents pregnancy. But being on the pill is not an indicator of having underage sex.
Approximately 26% of young girls have sex before the age of 16 Most are around 14-15. Fewer very young girls have sex and those who do are more likely to be coerced, regret the experience, struggle with access to healthcare and education, and lack family support. They are also far less likely to use any form of contraception. [More information on underage sex here]
What did the GPRD data say about different uses of hormonal contraception?
Unfortunately the data from the GPRD does not break down reasons for prescribing hormonal contraception to young women, so we cannot conclude precisely why they are using it. This hasn’t stopped media speculation it’s primarily for pregnancy prevention, wrongly suggesting all young girls on the pill are sexually active lolitas.
The media says teens don’t need parental consent to talk to a doctor. Is that true?
It is true practitioners do not have to tell parents if a young person consults with them (about any issue), guidance such as Gillick Competence and Fraser Guidelines (specifically for contraception). These set out the circumstances under which young people can get help without parental consent, and when parents or social services need to be involved. All of which happens with the awareness of a young person.
Generally practitioners want a parent or carer to be involved in supporting a young person. So providing health advice on any topic without a parent being involved tends to only happen in specific circumstances (explained in the links above). Before giving any advice practitioners are keen to establish the young person’s situation and find out what options they see themselves as having.
Aside from access to healthcare being a basic human right for any child or teen, there are sometimes very good reasons why a young person needs to talk about sensitive issues to their doctor. This may be when they live within a very strict home, or where their parents are absent or neglect them, or where they are subjected to abuse by their parents (or by others but are not protected by their parents).
So did the media make this story up?
Clearly ‘11 and 12 year old girls prescribed hormonal contraception with parents consent to prevent health problems’ doesn’t have the same salacious ring as ‘sexually active 11 year old girls’. The uncritical coverage does not refer to evidence based practice nor particularly includes reproductive health practitioners. Instead it relies heavily on the Christian Medical Association who have an anti sex education (and anti pre marital sex) agenda.
It wasn’t that the media lied about this story, certainly teens are using the pill for medical purposes and to prevent pregnancy. But this is not new. Doctors have been prescribing hormonal contraception to treat numerous complaints for decades. Just because it’s news to the media doesn’t mean it is not standard clinical practice.
Is sex education to blame?
Several news reports suggested the phenomena of young women using hormonal contraception was down to sex education – or would be made worse if sex education was implemented for young people. Indeed coverage on this was very confused on the actual or possible role of sex education in all this.
Currently sex education is not statutory across the UK and standards of delivery vary widely. Ofsted has recently produced a damning report on the state of UK sex education, while NICE is currently consulting on improving sex and relationships education in the UK. [More on what young people want from sex education here]
It seems much of the press coverage on the GPRD data is aimed at discrediting Ofsted and NICE’s suggestions that sex education be improved and appropriately tailored relationships education could begin with children aged 5.
Why was this coverage so poor?
There is an ongoing crusade by elements of the media to be anti young people, particularly young girls, and against all forms of sex education. And as we’ve already heard scandalous headlines about teenage nymphos sound a lot more exciting than a small subgroup of girls having the pill mainly for medical reasons.
However there are several other important reasons why the coverage was so bad.
Reproductive health is always framed as a two sided, moral debate
As you’ll see from the stories linked at the start of this post the media sets these stories up as moral debates where there are distinct baddies (doctors, trampy teens and anyone offering sex education) and goodies (Christian/Family groups, parents). The media focus is not to explore reasons why young women might use hormonal contraception, but to demonise young women generally and the medical profession alongside them.
Broadcast media tends to take this a step further inviting live debate between practitioners and moral authorities, and most of the calls I took from journalists today were seeking to pitch me into battle – cast in the unwinnable role of the ‘pro sex bogeywoman’ (as @badhedgehog observantly noted on Twitter).
Unsurprisingly this atmosphere does not allow clear information to be shared that might reassure parents or young people. Nor does it challenge poor media coverage, leaving the public still believing that loads of 11 year olds are a. on the pill and b. all promiscuous.
Many journalists have a poor understanding of reproductive health
Discussing this story with journalists provided a fascinating, if frustrating, insight into how many of them simply lack the basic sex education that would enable them to evaluate reproductive health data.
During the course of today I’ve spoken to 15 journalists, mostly working for radio and TV news stations, and 13 of which have been male.
Through these conversations I discovered none of the journalists knew hormonal contraception had medical uses. All of them assumed hormonal contraception was simply used to prevent pregnancy. And because of this assumption it hadn’t occurred to them to find out what else hormonal contraceptives might be used for.
They also were confused over what hormonal contraception was, in several cases not realising the pill was only one form. Most seemed to believe hormonal contraception just meant ‘the pill’. One journalist thought the injection couldn’t be a form of hormonal contraception because it wasn’t ‘a pill’, while another believed the contraceptive injection was ‘worse’ than the pill as it ‘lasted longer’ and made girls ‘more likely to have sex’.
Most of the journalists couldn’t work out why a young woman might opt for a hormonal contraceptive in injection form. They interpreted opting for an injection as easier for some than remembering to take a pill regularly as further evidence of fecklessness. This reinforced for them the stereotype of sexually lax behaviour they associated contraception use with.
Even those who accepted hormonal contraception could have additional uses still returned to the idea the main reason young people were using it was to have sex. Or believed if they were given hormonal contraception it would automatically lead to sex soon after. Or make girls more likely to act in loose ways.
Persuading them parents are mostly involved in decisions of hormonal contraception use with young girls proved pretty difficult. One journalist said ‘you’d go as far as saying a girl should go on the pill if she has heavy and painful period?’. Well, yes if that’s what she and her doctor agreed would help her. This particular journalist then asked me if I could come on air and say the first bit (parents should put their daughters on the pill) but not the second bit (explaining why they’d want to do this). Obviously I refused but you can see how even when presented with evidence to show a story is wrong journalists won’t move away from a particular angle.
Sadly while most journalists I spoke to did seem interested to learn about the medical reasons for using hormonal contraception and finding out more about it, once it became clear I wasn’t willing to participate in a ‘debate’ about whether young girls are sexually active or not, they were not interested in discussing things further. (It could be the journalists I spoke to aren’t representative of the media generally or were trying to make a particular debate point with their questioning, but my interpretation was most genuinely seemed ill informed about reproductive health)
Healthcare agencies, particularly in reproductive health, did not speak up
The whole case has highlighted for me the need for agencies promoting sexual and reproductive health to offer basic training for journalists. There is obviously a great need for many journalists to have information about how to understand clinical data, but also having an awareness of sexual and reproductive health to help them interpret this information.
Sadly the majority of organisations dealing with reproductive health (including NHS Choices, Nursing Times and the Department of Health) remained silent during the day – even when requested directly through twitter and email to get involved. This is sadly a common pattern where organisations miss key opportunities to deliver health information.
While this may be partly due to the way the media frames stories like this and practitioners don’t want to be cast as the bad guy, if enough people spoke out we could achieve so much.
As much as I have criticised the media here it is worth noting there were also many other responsible broadcasters and writers who did want to cover the story but they were struggling to find anyone to talk to them.
We cannot complain about poor media coverage if, as health practitioners and educators, we do not offer our services to ensure accurate information is shared.
How should the media have treated this story?
This really is a non story, but if the media had wanted to report it accurately they should have looked at the reasons why the contraceptive was prescribed, whether parents had consented to their daughter using hormonal contraception, and indicated proportionally how many young people were prescribed the pill for pregnancy prevention without parental consent. Indicating the numbers of 11-12 year olds on the pill as compared to the wider population in this age group would put this in perspective in terms of prevalence. And they should have written this in a way to highlight how to safeguard young people most at risk. Who we know mostly do not seek out medical help and are often also unable to get help within their families.
The take home message is?
Sadly bad science, scaremongering rhetoric and poor journalism makes it difficult for parents and young people to get accurate information. This may result in making young people more excluded from the health care they need.
Unfortunately if we do not challenge it we will continue to leave parents terrified and young people disempowered.
This piece appeared in a shorter form for The Times Science today as Too much too young: most 11-year-olds aren’t on the pill for sex
With grateful thanks to everyone on Twitter today who challenged this story, shared information about young people’s rights, and generally kept me going when I was getting fed up shouting about it!Tweet